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目的探讨美式整脊手法(Chiropractic)配合脊柱脉冲诊疗仪治疗小儿寰枢椎旋转半脱位的有效性。方法回顾性分析2004年7月至2014年8月,于我院门诊骨科就诊的37例寰枢椎旋转半脱位患儿,其中男27例,女10例,年龄3.5~12岁,平均7.9岁。发病前有明确上呼吸道感染病史的患儿占21.6%(8/37),有明确头颈部外伤史的占35.1%(13/37)。就诊时间为发病后当天至3个月不等。所有患儿均接受颈部活动范围检查,部分(年龄较大的患儿)接受视觉模拟评分(visual analogue scale,VAS)测量;同时接受颈椎正、侧、张口位X线检查,部分患儿加做寰枢椎螺旋CT扫描及图像三维重建检查。三维CT检查重点测量寰枢椎在纵轴和矢状轴上旋转畸形的角度。所有患儿均接受本研究第一作者给予的Chiropractic治疗和脊柱脉冲诊疗仪(Sigma公司,Neuromechinical Innovation公司,美国)的治疗。患儿在伤后2~3天内连续接受1次/天的治疗,随后改为2~3次/周,并佩戴颈托2周。治疗结束后给予影像学复查,治疗前后的VAS值进行统计学比较。结果治疗后多数患儿的疼痛症状获得明显改善。本组11例在治疗前后接受VAS测试,治疗前VAS评分7.2~10分,平均8.68分,治疗后VAS评分0~3分,平均1.75分,差异有统计学意义(P<0.01)。本组在治疗后接受影像学复查的病例共13例,但接受影像学复查的时间相差甚远(1.5小时至7年)。绝大多数患者影像学有明显好转,仅2例在复查X线片时对位不佳,尚需继续治疗和观察。结论Chiropractic是治疗小儿寰枢椎旋转半脱位有效方法之一,脊柱脉冲诊疗仪对小儿而言更具有依从性和安全性,两者配合使用可以增加疗效。三维螺旋CT能对寰枢椎在纵轴和矢状轴上旋转畸形的角度进行精确的测量,并对治疗有指导意义。
Objective To investigate the effectiveness of Chiropractic combined with spinal pulse therapy in pediatric atlantoaxial subluxation. Methods Retrospective analysis of 37 cases of atlantoaxial subluxation in our hospital from July 2004 to August 2014, 27 males and 10 females, aged from 3.5 to 12 years, with an average of 7.9 years . Before the onset of a clear history of upper respiratory tract infection in children accounted for 21.6% (8/37), clear history of head and neck injuries accounted for 35.1% (13/37). Treatment time ranging from the day after onset to 3 months. All children underwent neck range examination, and some (older children) underwent visual analogue scale (VAS) measurement. At the same time, they were examined by X-ray of the cervical spine, Do atlantoaxial spiral CT scan and image 3D reconstruction examination. Three-dimensional computed tomography (CT) examines the angle of rotational ataxia on the longitudinal and sagittal axes. All children received treatment with the Chiropractic and Spinal Pulse Diagnostic Instruments (Sigma, Neuromechinical Innovation, Inc., USA) given by the first author of this study. Children 2 to 3 consecutive days after injury received 1 / day treatment, then changed to 2 to 3 times / week, and neck care for 2 weeks. After the end of treatment, radiographic review was performed and VAS values before and after treatment were compared statistically. Results After treatment, most children’s pain symptoms were significantly improved. The group of 11 patients underwent VAS test before and after treatment. The VAS score was 7.2 to 10 before treatment, with an average of 8.68 points. After treatment, the VAS score was 0 to 3, with an average of 1.75 points. The difference was statistically significant (P <0.01). A total of 13 patients underwent radiographic review after treatment, but the time for radiographic review was far behind (1.5 hours to 7 years). The vast majority of patients with imaging improved significantly, only 2 cases of poor alignment in the review of X-ray film, still need to continue treatment and observation. Conclusion Chiropractic is one of the effective methods for the treatment of atlantoaxial subluxation in children. Spinal pulse diagnosis and treatment instrument is more compliant and safe for children. The combination of the two can increase the curative effect. Three-dimensional spiral CT can atlantoaxial axis in the longitudinal axis and sagittal axis rotation deformity point of view of the accurate measurement, and guidance for the treatment.